FOREWORD: JASC special issue on education in cytopathology Nayar, Ritu; Monaco, Sara E.
Journal of the American Society of Cytopathology JASC,
September-October 2021, 2021 Sep-Oct, 2021-09-00, 20210901, Letnik:
10, Številka:
5
Journal Article
Background
The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a useful framework for the diagnosis of salivary gland fine‐needle aspiration (FNA) biopsies. In this study, ...the MSRSGC was applied to salivary gland FNAs in pediatric patients to assess its usefulness and look at pitfalls.
Methods
The laboratory information system was queried over a 15‐year period for all salivary gland FNAs in patients 18 years old or younger. Patient demographics, FNA diagnosis categorized according to the MSRSGC, and follow‐up surgical pathology diagnoses were examined and correlated.
Results
Thirty‐two cases were identified, with an average age of 12 years (range, 0.6‐18 years). A majority of the cases (84.4%) were from the parotid region. Twenty of 32 cases (62.5%) had follow‐up resection. MSRSGC recategorization diagnoses of the 32 FNA cases were 34% benign neoplasm, 31% nonneoplastic, 16% nondiagnostic, 9% atypia of undetermined significance, 3% salivary neoplasm of uncertain malignant potential, 3% suspicious for malignancy, and 3% malignant. Overall, the sensitivity and specificity were 100% and 80%, respectively. On follow‐up resection, 55% were neoplastic: pleomorphic adenomas (n = 6; 55%), pilomatricoma (n = 3; 28%), mucoepidermoid carcinoma (n = 1; 9%), schwannoma (n = 1; 9%), and myofibroma (n = 1; 9%).
Conclusions
The MSRSGC performed fairly well in the pediatric population with a low overall risk of malignancy (6%) and high sensitivity. Although the majority of pediatric salivary gland FNAs were benign, 55% of resected cases were positive for a neoplasm, with benign neoplasms outnumbering malignancy. Challenging entities included inflammatory conditions, like immunoglobulin G4‐related sialadenitis, and skin and soft tissue lesions near the salivary gland.
The usefulness of the newly introduced Milan system for reporting salivary gland cytology has been studied for adult patients in only a few institutions. Our study, which evaluated the usefulness of the Milan system for pediatric patients at an academic children's hospital, showed high sensitivity for the detection of salivary gland neoplasms/lesions in kids with overall low malignancy rates and highlighted morphological pitfalls through a detailed cytologic‐histologic correlation.
Introduction
Telecytology for second opinion consultation has largely been limited by technical issues, such as the inability to focus well on cellular material. Nevertheless, international ...telecytology consultation was undertaken at our institution with partners in China and Italy. To overcome issues with scanning cytology slides, we adopted a cell‐block (CB) preference for teleconsultation.
Methods
Telecytology consultation cases received over a 7.5‐year period were retrospectively reviewed. Cytology glass slides were scanned without Z‐stacking using different whole slide scanners. For one referring site, only haematoxylin‐eosin‐stained CBs were scanned, as well as immunostains requested by consultants. For another host centre, aspirate smears were also scanned in some cases.
Results
A total of 51 non‐gynaecological cases (44 CB only) were evaluated from 48 patients. The specimens included pleural fluids (19), pancreas (14), lymph nodes (6), peritoneal fluids (2) and miscellaneous samples (10). The cytological diagnoses spectrum included 16 (31.37%) cases positive for malignancy, 7 (13.72%) positive for neoplasm, 6 (11.76%) suspicious for malignancy, 10 (19.60%) atypical, 10 (19.60%) negative for malignancy and 2 (3.92%) non‐diagnostic. In 42 (82.35%) cases, immunocytochemistry was requested. Turn‐around‐time ranged from 1.5 to 306 hours.
Conclusions
Our experience shows that international telecytology for consultation purposes involving non‐gynaecological cases is feasible. A second opinion interpretation was rendered in the majority (64.7%) of cases. Utilising CB only for cytology consultations by whole slide imaging solved focus issues that typically plague evaluation of cytology aspirate smears.
The role of telecytology for consultation is emerging. This paper describes the authors experience with the use of cell blocks and whole slide imaging for international telecytology consultation and outlines key factors responsible for a successful telecytology consultation service at an academic institution.
Introduction
Rapid on‐site evaluation (ROSE) has been widely used to improve diagnostic adequacy and facilitate specimen triage. Telecytology ROSE has gained popularity recently and shown high ...concordance with traditional ROSE. However, telecytology involves multiple personnel and technical devices that could introduce additional errors. The aim of this paper is to share errors encountered and lessons learned since employing telecytology for ROSE at our institution.
Methods
The laboratory information system was searched for all documented telecytology ROSE errors from 2017 to 2019. These errors were subclassified as technical errors, cytotechnologist‐related errors and pathologist‐related errors. The following details were recorded for each reported event: type of error, reason for error, ROSE diagnosis, final diagnosis and actions taken to avoid future errors.
Results
Telecytology ROSE errors were documented in 46 (1.3%) sessions. Ten (22%) had technical errors, 13 (28%) were owing to cytotechnologist errors and 23 (50%) were attributed to pathologist interpretation errors. The majority of the technical (90%) and cytotechnologist errors (85%) occurred within the first year of implementation of telecytology. Common ROSE misinterpretation errors included missing microorganisms, misclassifying neuroendocrine tumours as other neoplasms and overcalling malignancy on gastrointestinal endoscopic procedures.
Conclusions
A variety of errors may occur during telecytology ROSE. While some errors are inevitable (eg, information technology downtime), certain telecytology errors can be reduced by increasing staff familiarity with the system, providing timely feedbacks and taking prompt corrective actions. We recommend establishing a mechanism to document and act upon recorded errors as part of a telecytology quality improvement programme.
This article describes the experience of a unit which has utilised Telecytology for rapid on‐site evaluation (ROSE) since 2017. Although considered successful, the diagnostic challenges and technical issues are shared to assist others who are considering or planning to utilize telecytology for ROSE.
Summary Epidermal growth factor receptor ( EGFR ) and v-Ki-ras 2 (KRAS; viral Kirsten rat sacoma 2 oncogene homolog) oncogenes are predictors of response to EGFR -targeted therapy in lung carcinomas. ...Morphologic heterogeneity of lung carcinomas is reflected at the molecular level and may confound interpretation of immunohistochemistry, fluorescence in situ hybridization, and mutational assays, which are all used for analysis of KRAS and EGFR genes. Furthermore, molecular characteristics may differ between the primary tumor and corresponding metastases. The aim of this study was to determine if the KRAS and/or EGFR status of primary and metastatic lung carcinoma differs. Three hundred thirty-six cases of primary lung carcinomas were tested for EGFR and KRAS , and 85 cases had a metastasis (25%). Of the 40 cases (47%) with sufficient material for EGFR and KRAS mutational analysis, there were 11 (27.5%) primary tumors and 4 (10%) metastases identified with a KRAS mutation. Of the cases with EGFR fluorescence in situ hybridization results, there were 3 (8%) primary tumors and 8 (24%) metastases that were fluorescence in situ hybridization positive. Overall, there were 9 cases (22.5%) with discordant KRAS status and 11 cases (32.5%) with discordant EGFR fluorescence in situ hybridization status. Our results suggest that the EGFR and KRAS status of primary lung carcinomas may not predict the status in the corresponding metastases. This observation may have important implications for molecular testing for targeted therapies.
Background
Lung carcinoma arising in association with scar tissue is a well‐reported but much debated phenomenon. Scar tissue complicates imaging and pathologic tumor measurement for cancer staging. ...To the best of our knowledge, the cytological findings in lung scar carcinoma (LSC) have not been described in the literature. Therefore, the aim of this study was to characterize the findings in fine‐needle aspirations (FNA) from histologically confirmed LSCs.
Methods
LSCs were identified on retrospective search. Cases with preoperative FNA material were reviewed, including non‐scar cases that were used for comparison. The clinical and histopathology findings were recorded.
Results
Twenty‐seven cases associated with scar tissue had material for review and 35 cases not associated with scar tissue were used for comparison. The proportion of fibrosis in resection specimens ranged from 10% to 80%. Five (19%) FNA cases were hypocellular. There was no statistically significant difference between the scar and non‐scar groups in terms of overall cellularity and diagnostic categories (P = .113 and P = .17, respectively). There was correlation between cytology and dominant pattern on histology in 19 (79%) adenocarcinoma cases. Spindle cells and fibrous or fibroelastotic fragments were present in 22 (81%) cases.
Conclusion
This is the first study describing the cytology associated with LSCs. The presence of fibrosis did not adversely impact cellularity, which is likely due to multiple excursions and selective microdissection of tumor cells by the FNA needle. The cytomorphological and histological patterns correlated in most cases. FNA is able to provide a preoperative diagnosis of carcinoma despite the presence of fibrosis.
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